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Interventional radiology in the management of portal hypertension.

Punamiya SJ - Indian J Radiol Imaging (2008)

Bottom Line: Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology.The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods.This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.

ABSTRACT
From being a mere (though important) diagnostic tool, radiology has evolved to become an integral part of therapy in portal hypertension today. Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology. The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods. This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts. When any of these procedures cannot be performed due to anatomical or physiological reasons, the symptoms can often be controlled effectively with embolization of varices or balloon-occluded retrograde transvenous obliteration of varices (BRTO). This article briefly describes the procedures, their results, and their current status in the treatment of portal hypertension.

No MeSH data available.


Related in: MedlinePlus

Percutaneous transhepatic embolization of varices in a patient with massive variceal bleeding. After percutaneous access into the portal vein (A), the venogram shows retrograde flow in the portal vein, filling varices from the left and posterior gastric veins; the gastric vein was selectively cannulated and embolized with coils (B). After this, there was reversal of flow in the portal vein and occlusion of the varices, providing short-term control of bleeding
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Figure 0009: Percutaneous transhepatic embolization of varices in a patient with massive variceal bleeding. After percutaneous access into the portal vein (A), the venogram shows retrograde flow in the portal vein, filling varices from the left and posterior gastric veins; the gastric vein was selectively cannulated and embolized with coils (B). After this, there was reversal of flow in the portal vein and occlusion of the varices, providing short-term control of bleeding

Mentions: PTE was the earliest intervention performed for portal hypertension and was first described by Lunderquist and Vang in 1974 to treat intractable variceal bleeding. In this technique, the portal vein is catheterized by a percutaneous transhepatic approach and the gastric vein feeding the varix is embolized with ethanol, steel coils, or cyanoacrylate glue [Figure 9]. When first described, PTE appeared to be a highly effective procedure, successfully controlling bleeding in 70-90% of patients. However, the underlying PHT was unaffected and, consequently, bleeding recurred in 38-70% of patients within 6 months and in 71-90% after 2 years. In addition, it carried a failure rate of 9%, particularly in patients with portal vein thrombosis or small livers with marked ascites.[34] PTE itself was responsible for inducing portal vein thrombosis in up to 36% of patients.[35] All these factors, and the emergence of endoscopic therapy (EST), led to a decline in the procedure; EST had better survival rates and lower rebleeding rates. The introduction of TIPS and BRTO further antiquated the procedure, and PTE is now very rarely performed.


Interventional radiology in the management of portal hypertension.

Punamiya SJ - Indian J Radiol Imaging (2008)

Percutaneous transhepatic embolization of varices in a patient with massive variceal bleeding. After percutaneous access into the portal vein (A), the venogram shows retrograde flow in the portal vein, filling varices from the left and posterior gastric veins; the gastric vein was selectively cannulated and embolized with coils (B). After this, there was reversal of flow in the portal vein and occlusion of the varices, providing short-term control of bleeding
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2747437&req=5

Figure 0009: Percutaneous transhepatic embolization of varices in a patient with massive variceal bleeding. After percutaneous access into the portal vein (A), the venogram shows retrograde flow in the portal vein, filling varices from the left and posterior gastric veins; the gastric vein was selectively cannulated and embolized with coils (B). After this, there was reversal of flow in the portal vein and occlusion of the varices, providing short-term control of bleeding
Mentions: PTE was the earliest intervention performed for portal hypertension and was first described by Lunderquist and Vang in 1974 to treat intractable variceal bleeding. In this technique, the portal vein is catheterized by a percutaneous transhepatic approach and the gastric vein feeding the varix is embolized with ethanol, steel coils, or cyanoacrylate glue [Figure 9]. When first described, PTE appeared to be a highly effective procedure, successfully controlling bleeding in 70-90% of patients. However, the underlying PHT was unaffected and, consequently, bleeding recurred in 38-70% of patients within 6 months and in 71-90% after 2 years. In addition, it carried a failure rate of 9%, particularly in patients with portal vein thrombosis or small livers with marked ascites.[34] PTE itself was responsible for inducing portal vein thrombosis in up to 36% of patients.[35] All these factors, and the emergence of endoscopic therapy (EST), led to a decline in the procedure; EST had better survival rates and lower rebleeding rates. The introduction of TIPS and BRTO further antiquated the procedure, and PTE is now very rarely performed.

Bottom Line: Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology.The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods.This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.

ABSTRACT
From being a mere (though important) diagnostic tool, radiology has evolved to become an integral part of therapy in portal hypertension today. Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology. The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods. This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts. When any of these procedures cannot be performed due to anatomical or physiological reasons, the symptoms can often be controlled effectively with embolization of varices or balloon-occluded retrograde transvenous obliteration of varices (BRTO). This article briefly describes the procedures, their results, and their current status in the treatment of portal hypertension.

No MeSH data available.


Related in: MedlinePlus